Improvement of Hyperphosphatemia following Patient Education

Abstract

Phosphorus is important not only for maintaining healthy bone metabolism but also for many other biological functions such as cell membrane integrity and cellular energy systems. In patients with end-stage renal disease, decreased renal excretion of phosphorus results in hyperphosphatemia, which causes secondary hyperparathyroidism and/or an increase in the serum calcium x phosphorus product. A high serum calcium x phosphorus product accelerates vascular calcification, 1 which is reported to be independently associated with mortality in patients on hemodialysis. 2,3 Hyperphosphatemia also is an independent risk factor for mortality in these patients. 2-4 For example, the relative mortality risk at a serum phosphate concentration greater than 6.5 mg/dL is more than twice (2.02; CI 1.10 to 3.73) that of a normal serum phosphate concentration (3.0-5.0 mg/dL), after adjusting for several factors. 5 A serum phosphate concentration greater than 5.0 mg/dL is independently associated with an increased risk of death in hemodialysis patients. 4 MINORI SATOH, AKIKO KOIZUMI, SATOSHI IZUMI, YASUHIRO KUGOH, ERIKOKIRIYAMA, EMIKO OGUMA, TAKU FURUKUBO, CHIHARU MATSUNAGA, TOMOYUKI YAMAKAWA, DAISUKE KADOWAKI, AND SUMIO HIRATA Background: Patient adherence to a phosphate binder treatment regimen is crucial in the management of hyperphosphatemia. Nonadherence may be due to a lack of patient knowledge of the nature and treatment of the illness.Objective: To investigate the effectiveness of pharmacist-provided education regarding phosphate binders and hyperphosphatemia on serum phosphate concentration and calcium x phosphorous product in hemodialysis patients. Methods:A total of 398 hemodialysis patients who were prescribed phosphate binders participated in a pharmacist-run, education-based intervention session regarding phosphate binders and hyperphosphatemia. Each session was individualized on the basis of patient knowledge, assessed via a questionnaire. Particular attention was given to correcting patient misconceptions. Patients with elevated serum phosphate received additional education. Mean serum concentrations of phosphate and calcium, averaged from 4 measurements obtained at both baseline and postintervention, were compared to evaluate the efficacy of the intervention.Results: Postintervention, patients with the highest baseline serum phosphate concentrations (≥7.0 mg/dL) showed a significant decrease in mean ± SD serum concentrations of phosphate and calcium-phosphate product (7.4 ± 0.4 mg/dL and 72.6 ± 6.4 mg 2 /dL 2 to 6.5 ± 0.8 mg/dL and 63.1 ± 8.4 mg 2 /dL 2 , respectively; p < 0.001). Likewise, patients with serum phosphate concentrations ranging from 6.0-6.9 mg/dL showed a significant decrease in both parameters after educational intervention (p < 0.05 and p < 0.005, respectively).Conclusions: An education session regarding phosphate binders and hyperphosphatemia, provided by pharmacists for hemodialysis patients, appeared effective in reducing serum phosphate concentrations and calcium x phosphorus product, thus contri...

Effectiveness of educational or behavioral interventions on adherence to phosphate control in adults receiving hemodialysis: a systematic review

“…Appendix IV provides an overview of the characteristics of included articles and Appendix V provides a list of excluded studies with reasons for exclusion. Of the studies included in the review, eight were RCTs, 26,28,38,40,42,43,47,48,50 nine before-after studies 5,12,29,31,39,41,[44][45][46] and one cohort study. 37 A total of 2,760 patients were included; 11 studies had more than 50% males, 12, 28, 31, 37-40, 43, 45-47 four studies had less than 50% males 26,41,42,44 and three studies did not provide the sample demographics.…”

“…37 A total of 2,760 patients were included; 11 studies had more than 50% males, 12, 28, 31, 37-40, 43, 45-47 four studies had less than 50% males 26,41,42,44 and three studies did not provide the sample demographics. 5,29,48 Sample sizes ranged from 34 to 184 participants per group, although three studies had larger samples: Mayne et al 39 (n = 702) and Satoh et al 45 (n = 398) did not have control groups, and Van Camp et al 31 had unequal group sizes, with 41 in the intervention group and 216 controls. The geographical location of the studies varied, with studies conducted in America, 5,39,40,46 the United Kingdom, 12,47,48 Australia, 37,44 Belgium, 31 Sweden, 29 China, 28 Japan, 45 Lebanon, 26,42 Spain, 38 and Taiwan.…”

“…41 One study did not mention the country. 43 Participant inclusion criteria varied between studies: an average monthly serum phosphate level of greater than 1.6 mmol/L (5.5 mg/dL) for three months before study commencement, 5,28,29,38,40,41,48 currently prescribed phosphate binder medication, 5,28,43,45,46 or three to six months on HD. 28,38,43…”

A bundled phosphate control intervention (4Ds) for adults with end‐stage kidney disease receiving haemodialysis: A cluster randomized controlled trial protocol

“…Nurses provide educational support for adherence to phosphate control methods (Brogdon, ; Richard, ). The renal dietician encourages adherence to dietary phosphate restrictions and the renal pharmacist provides patient education on how and when to take medications (Satoh et al., ). Evidence for phosphate control improvement ought to involve bundling the education of phosphate control methods together within a self‐management framework.…”

“…Nurses provide educational support for adherence to phosphate control methods (Brogdon, 2013;Richard, 2006). The renal dietician encourages adherence to dietary phosphate restrictions and the renal pharmacist provides patient education on how and when to take medications (Satoh et al, 2009).…”